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Hawaii N-172 Physician Certification (Blind, Deaf)

Hawaii residents who are blind, deaf or totally disabled can claim special income tax and general excise tax exemptions with Form N-172. Part II on page 2 is the professional certification, with an eye exam section, a hearing exam section and a disability report, and the certifier completes only the one that applies.

Who completes it

The taxpayer completes Part I and signs. Section A is done by an ophthalmologist or optometrist, Section B by a board-certified otolaryngologist or licensed audiologist, and Section C by a physician under section 235-1, HRS; the certifier signs with license number, expiration and licensing authority.

Submitting and payment

How to submit it
The claim is filed with the Hawaii Department of Taxation once, and again only if re-examination is indicated; the taxpayer and certifying clinician keep copies.
Who pays
The Department of Taxation sets no fee and the form does not say who pays the certifying professional.

Good to know

  • Section A asks whether corrected acuity is 20/200 or worse in the better eye or the field is under 20 degrees; Section B uses an 82 dB ASA (92 dB ANSI 1969) average loss.
  • Each section asks whether the applicant should be re-examined for tax purposes and, if so, when.
  • Under HAR 18-235-1.14, adopted in 2019, self-employment gross earnings above a set threshold disqualify a person from totally disabled status.
  • Honolulu requires N-172 with its E-8-10.6 and E-8-10.7 real property exemption claims, so the same certification serves county property tax.

Get the official form

Download the current version from the source each time; forms change without notice.

Claim for Tax Exemption by Person with Impaired Sight or Hearing or by Totally Disabled Person and Physician's Certification

Official pagePDF

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Who can certify Hawaii Form N-172?

It depends on the section. Blindness (Section A) must be certified by a qualified ophthalmologist or optometrist, deafness (Section B) by a board-certified ear, nose and throat specialist or licensed audiologist, and total disability (Section C) by a physician as described in section 235-1, HRS.

Does Form N-172 have to be filed every year?

No. The form is filed once with the Department of Taxation, and again only if the certifying professional indicates the applicant should be re-examined for tax purposes. It must be signed by both the taxpayer and the certifier or it is not processed.

What does the blind applicant authorization on N-172 do?

When Section A is completed, the applicant may sign an authorization letting the Department of Taxation share their name, Social Security number, address, eye condition and blindness certification with Ho'opono Services for the Blind, which maintains the state register of legally blind persons.